Dan Promotion Seminar App Fom 7310 Orlando 2 2

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					                     2010 USAT Jr. Olympic & Sr. National
                    USAT Dan Seminars for Test Preparation
                     And Promotion Testing Requirements
                             Fax or e-mail this form before June 25, 2010.
                      USAT (719) 866-4642 (Fax), becie.seals@usa-taekwondo.us

JULY 3, 2010 (SAT.) Orange County Convention Center (Room Location TBD)
2pm-4pm             WTF Black Belt Poomsae Seminar
                    GM Russel Ahn/Certified by WTF
4-4:30pm            Breaking Techniques - GM Kevin Bang
                    Power Breaking & Multiple Direction Board Breaking
4:45-6pm            Dan rank promotion - Official USATMAC Test Board

                          Seminar and Testing Application Form
Name: ____________________________ Birth Date________ Signature:_____________________________

Current Rank ______ Applying Rank______ Organization Issued Your Rank & Date: ___________________

1. Kukkiwon (     ) Dan #_________________ Date Issued ________________ (Provide a copy of certificate)

2. USAT-MAC (         ) Dan #______________Date Issued ________________ (Provide a copy of certificate)

3. Others: _______________________________________________________ (Provide a copy of certificate)

Address:_____________________________________________________ St _______ Zip_______________

Phone: Cell _________________ Business_______________ E-mail ________________________________

Name of your school/Club __________________________________________________________________

Instructor’s name ___________________________________________ His/Her Rank ___________________

Your School/Club USAT # _____________ Your USAT member # ___________________________________

Payment: Total Fee $____________ Method of payment: Visa, MC, others____________________________

Card # _______________________________________________ Exp. ___________ Code ______________

Cardholder’s Name:____________________________ Cardholder’s Signature: _______________________

                     2010 USAT Jr. Olympic & Sr. National
                  Seminars for Test Preparation and Testing
Important Information for Test

Poomsae: 3 forms will be tested.

1. Taeguk # 8
2. One form from the 3rd or 4th Kukkiwon Dan mandatory forms
3. One form of your choice.

Your choice of between 3-5 boards broken from different directions.
(Boards will be available for sale from the Vision booth)


Testing Applicants:        $50.00
Seminar only (no test):    $80.00 (Certificate of completion given and 2 hours USAT Continuing
Education credit given toward future instructor certification program completion. 20% discount toward
next seminar.)

     There will no refunds given if candidate does not successfully pass or complete test.


3RD Dan:       $175.00
4th Dan:       $250.00
5th Dan:       $350.00
6th Dan:       $450.00
7th Dan:       $550.00

8th and 9th Dan candidates: Please contact USAT Martial Arts Commission Chairman Grandmaster
J.P. Choi directly at joon.p.choi@gmail.com to discuss.

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